Breast Cancer

Overview

What is Breast Cancer?

The term breast cancer refers to a malignant tumor that has developed from cells in the breast. The breast is composed of two main types of tissues: glandular tissues and stromal (supporting) tissues. Glandular tissues house the milk-producing glands (lobules) and the ducts (the milk passages) while stromal tissues include fatty and fibrous connective tissues of the breast. The breast is also made up of lymphatic tissue-immune system tissue that removes cellular fluids and waste.

There are several types of tumors that may develop within different areas of the breast. Most tumors are the result of benign (non-cancerous) changes within the breast. For example, fibrocystic change is a non-cancerous condition in which women develop cysts (accumulated packets of fluid), fibrosis (formation of scar-like connective tissue), lumpiness, areas of thickening, tenderness, or breast pain.

Breast Cancer Risk factors

A risk factor is anything that makes it more likely you'll get a particular disease. Some risk factors, such as your age, sex and family history, can't be changed, whereas others, including weight, smoking and a poor diet, are under your control.

Other factors that may make you more susceptible to breast cancer include : -

Age : - Your chances of developing breast cancer increase with age. Close to 80 percent of breast cancers occur in women older than age 50. In your 30s, you have a one in 233 chance of developing breast cancer. By age 85, your chance is one in eight.

A personal history of breast cancer : - If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.

Family history : - If you have a mother, sister or daughter with breast or ovarian cancer or both, or a male relative with breast cancer, you have a greater chance of also developing breast cancer

Radiation exposure : - If you received radiation treatments to your chest as a child or young adult, you're more likely to develop breast cancer later in life. Your risk is greatest if you received radiation as an adolescent during breast development.

Excess weight : - The relationship between excess weight and breast cancer is complex. In general, weighing more than is healthy increases your risk, particularly if you gained the weight as an adolescent. But risk is even greater if you put the weight on after menopause. Your risk also is greater if you have more body fat in the upper part of your body.

Early onset of menstrual cycles : - If you got your period at a young age, especially before age 12, you may have a greater likelihood of developing breast cancer. Experts attribute this risk to the early exposure of the breast tissue to estrogen.

Late menopause : - If you enter menopause after age 55, you're more likely to develop breast cancer. Experts attribute this to the prolonged exposure of the breast tissue to estrogen.

First pregnancy at older age : - If your first full-term pregnancy occurs after age 30, or you never become pregnant, you have a greater chance of developing breast cancer. Although it's not entirely clear why, an early first pregnancy may protect breast tissue from developing genetic mutations that result from estrogen exposure.

Hormone therapy : - Treating menopausal symptoms with the hormone combination of estrogen and progesterone for four or more years increases your risk of breast cancer.

Birth control pills : - Use of birth control pills is associated with an increased risk of breast cancer in premenopausal women. The risk seems to be greater for women who use birth control pills for four or more years before their first full-term pregnancy.

Smoking : - Evidence is mixed on the relationship between smoking and breast cancer risk. Some studies show no link between cigarette smoking and exposure to secondhand smoke and breast cancer.

Excessive use of alcohol : - Women who drink more than one alcoholic beverage a day have about a 20 percent greater risk of breast cancer than do women who don't drink. To reduce your breast cancer risk, limit alcohol to no more than one drink daily.

Symptoms of Breast Cancer

Early breast cancer usually does not cause pain. In fact, when it first develops, breast cancer may cause no symptoms at all. But as the cancer grows, it can cause these changes:
1. a lump or thickening in the breast or armpit
2. a change in the size or shape of the breast
3. discharge from the nipple
4. A change in the color or texture of the skin of the breast or areola (such as dimpling, puckering, or scaliness).

Diagnosis of Breast Cancer

Treatment decisions depend on these findings. The first step in the work-up of breast disease is usually a physical exam by a doctor or nurse practitioner. Mammography and ultrasound may be important additions to the physical examination. On the basis of these evaluations, the decision may be made to confirm a clinical impression with a tissue biopsy.

Imaging for Breast Cancer : -
Imaging is an important component used to diagnose breast cancer and to evaluate the stage and extent of disease in breast cancer patients

Screening Mammography : -
A mammogram is a low-dose X-ray of the breast. This is the best test we have to screen women for breast cancer. A Screening Mammogram consists of two "pictures" of each breast. If an area on the mammogram looks suspicious or is not clear, additional mammograms with different views may be needed. Annual screening mammography is recommended for all women over 40 years old.

Diagnostic Mammography : -This is a mammogram used for problem-solving, rather than for screening. For instance, if a patient has a lump in her breast, a directed investigation of that area is performed. This is also done when a particular finding in the breast is being followed over time. A diagnostic mammogram is tailored to the patient's case and is carefully monitored by a radiologist, who interprets the images and determines whether there is any need for further tests.

Ultrasonography : -Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with Diagnostic Mammography or MRI to answer questions about a specific area of the breast. Because it uses sound waves instead of X-Rays, ultrasound provides information that is different and often complementary to the mammogram.

Breast MRI : -Magnetic resonance imaging (MRI) can be used to look specifically at the breast. Each exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by a radiologist. It is non-invasive and no radioactivity is involved. The technique is believed to have no health hazards in general.

Biopsy for Breast Cancer

One way to find out if a breast lump or abnormal tissue is cancer is by having a biopsy. During a biopsy, a surgeon, a pathologist or a radiologist removes a portion or all of the suspicious tissue. The suspicious tissue is examined under a microscope by a pathologist who checks for cancer cells and makes the diagnosis. The following are different types of biopsies as well as how you can best prepare yourself for each of them. The following are different types of biopsies.

Fine Needle Aspiration (FNA) Biopsy : -
FNA samples a woman's lump using a thin small needle that leaves a mark no bigger than a needle stick from a blood test. FNA often allows us to diagnose a lump within two to three days

Stereotactic Core Biopsy : -
This procedure was developed as a less invasive way to obtain tissue samples for diagnosis. It involves removing tissue with a biopsy needle while your breast is compressed in a way similar to a mammogram. This biopsy requires less recovery time than surgery and causes no significant scarring

Needle (Wire) Localization Biopsy : -
This type of biopsy involves the use of a needle and wire to locate the abnormal tissue and surgery to remove it. Needle localization is performed when you have an abnormality on a mammogram that cannot be felt. It is an outpatient biopsy that is done in two steps on the same day.

Treatment of a Breast Cancer in India

Mastectomy in India
Mastectomy is the surgical removal of a breast. Surgery is presently the most common treatment for breast cancer. Following mastectomy, immediate or delayed breast reconstruction is possible in many instances.

Types of Mastectomy

There are several different types of surgical procedures used to treat breast cancer. Depending on the location or surgeon who performs the procedure, different terms may be used.

Surgical procedures for breast cancer include : -

Simple or total mastectomy: removal of the breast, with its skin and nipple, but no lymph nodes. In some cases, a separate sentinel node biopsy is performed to remove only the first one to three axillary (armpit) lymph nodes.

Modified radical mastectomy: removal of the entire breast, nipple/areolar region, and often the axillary lymph nodes. This is the most common form of mastectomy performed today.

Radical mastectomy: removal of the entire breast, nipple/areolar region, the pectoral (chest) major and minor muscles, and lymph nodes. This procedure is rarely performed today.

Quandrantectomy: removal of a quarter of the breast, including the skin and breast fascia (connective tissues). The surgeon may also perform a separate procedure to remove some or all of the axillary (armpit) lymph nodes, either an axillary node dissection or a sentinel node biopsy.

Partial or segmental mastectomy: removal of a portion of the breast tissue and a margin of normal breast tissue. This procedure usually involves removing less tissue than a quandrantectomy but more than a lumpectomy or wide excision.

Lumpectomy or wide excision: removal of the breast cancer tumor and a surrounding margin of normal breast tissue.

Excisional biopsy also the removal of the breast tumor and a surrounding margin of normal breast tissue. Sometimes further surgery is not needed if an excisional biopsy successfully removes the entire breast cancer tumor. This is most likely to occur if the breast tumor is very small. An excisional biopsy may be performed with "needle" or "wire" localization.

In the past, radical mastectomy was the frequently performed on women with breast cancer. However, experts have found that modified radical mastectomy is equally effective in most cases, and therefore, it has become the most common type procedure for removing the entire breast.

[ Radical Mastectomy ]

[ Modified Radical Mastectomy ]

[ Simple (total) Mastectomy ]

[ Partial Mastectomy ]

Axillary Node Dissection in India

Axillary node dissection, the surgical removal of the axillary (armpit) lymph nodes, is usually performed on patients with invasive cancers. A radical mastectomy, modified radical mastectomy, or lumpectomy operation often includes axillary node dissection (this involves a separate incision for lumpectomy patients). After surgery, the axillary lymph nodes are examined under a microscope to determine whether the cancer has spread past the breast and to evaluate treatment options.

The most common side effect of axillary node dissection is lymphedema: chronic swelling of the arm. Approximately 10% to 20% of patients typically experience lymphedema when axillary node dissection is combined with radiation therapy. Patients are encouraged to report any tightness or swelling of the arm to their physicians as soon as symptoms occur to prevent possible long-term suffering. Other side effects of axillary node dissection include temporary to permanent limitations of arm and shoulder movement and numbness in the upper-arm skin.

Side effects of axillary node dissection : -

lymphedema (swelling of the arm).

limitations of arm/shoulder movement.

numbness of upper-arm skin.

Sentinel Lymph Node Biopsy in India

Sentinel lymph node biopsy is a new procedure that involves removing only one to three sentinel lymph nodes (the first nodes in the lymphatic chain). To perform sentinel node biopsy, a radioactive tracer and/or blue dye is injected into a region of a tumor. The dye is then carried to the sentinel node (the lymph node most likely to be cancerous if the disease has spread from its original origin). If the surgeon determines that the sentinel node contains cancer, more lymph nodes are removed and examined. Surgeons detect the sentinel lymph node by either spotting the blue dye or by measuring a node's radioactivity with a Geiger counter. If the removed sentinel node is cancer-free, additional lymph node surgery may be avoided. Research continues to show that sentinel lymph node biopsy may safely eliminate the need to remove many lymph nodes and reduce the chances of lymphedema (chronic arm swelling). Currently, researchers are investigating whether sentinel lymph node biopsy should be performed routinely in the place of axillary node dissection.

Lumpectomy in India

Lumpectomy is the surgical removal of a cancerous lump (or tumor) in the breast, along with a small margin of the surrounding normal breast tissue. Lumpectomy may also be called wide excision biopsy, breast conserving therapy or quadrantectomy (this latter term is used when up to one fourth of the breast is removed). The procedure is often performed on women with small or localized breast cancers and can be an attractive surgical treatment option for breast cancer because it allows women to maintain most of their breast after surgery. Several studies have shown that women with small breast tumors have an equal chance of surviving breast cancer regardless of whether they have a lumpectomy, followed by a full course of radiation therapy, or mastectomy (complete breast removal, which generally does not require post-operative radiation treatment).

Chemotherapy in India

This section is intended to provide general information on chemotherapy for breast cancer patients and to discuss a variety of possible side effects of chemotherapy drugs. Because chemotherapy regimens are individually tailored, the types of drugs administered and their side effects will vary considerably. While this article discusses many of the side effects of chemotherapy in detail, it is important to note that the majority of the side effects associated with chemotherapy are temporary and only occur during or immediately after treatment. In the vast majority of cases, the benefits of treating cancer with chemotherapy far outweighs the risks or inconveniences of any side effects. Chemotherapy is only one possible treatment for breast cancer and may be used in addition to surgery or other treatments. Patients should discuss all aspects of chemotherapy and breast cancer treatment with their physician or cancer treatment team.
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Radiation Therapy for the Treatment of Breast Cancer in India

Radiation therapy (or radiotherapy) uses high-energy rays to stop cancer cells from growing and dividing. Radiation therapy is often used to destroy any remaining breast cancer cells in the breast, chest wall, or axilla (underarm) area after surgery. Occasionally, radiation therapy is used before surgery to shrink the size of a tumor. A common treatment for early stage breast cancer is breast-conserving therapy. Breast-conserving therapy (BCT) is the surgical removal of a breast lump (lumpectomy) and a surrounding margin of normal breast tissue. BCT is typically followed by at least six to seven weeks of radiation therapy. Treatment with radiation usually begins one month after surgery, allowing the breast tissue adequate time to heal. Radiation therapy may occasionally be recommended for women to destroy remaining cancer cells after mastectomy (surgical removal of the affected breast) or to shrink tumors in patients with advanced breast cancer.
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